As the business model continues to migrate from Fee For Service (FFS) payment toward quality care payments, the incentive payments and approach of Pediatric practices can change. It is interesting to note that many quality programs provided by payers have a minimum practice panel size. The reason for this is there needs to be enough patients to providing statistical significance as well as effective management. Many small/solo practices do not meet the minimum patient panel size since they have a smaller overall panel of patients than a larger group. Each practice needs to evaluate the time and effort for these programs as well as the potential incentive. As a practice increases the size of their patient panel, the opportunity for some payers can be significant.
Quality Care Metrics in Pediatrics
There are a number of core quality care metrics that payers might evaluate and provide additional quality incentive dollars for a Pediatric practice. These metrics include ability for the practice to conduct six well visits within 15 months of a child’s life as well as annual well visits for 3-5 year old as well as adolescent. The PediatricXpress system has a well visit work list tool that shows a list of patients due for a well visit per the practice well visit schedule. This tool, if leveraged by the staff at the practice, helps the pediatric practice track and bring in well visits to optimize quality care, revenue and potential performance on quality performance metrics related to well visits.
Usually payers identify one or more immunization metrics for quality care metrics in a pediatric practice. Some payers evaluate immunization performance for patients that reach 3 years of age while other might while other payers might also evaluate performance of percent of patients vaccinated with the HPV vaccine. The PediatricXpress system contains multiple vaccine tools to identify patients that are behind on vaccinations. The staff can use this tool each day to identify patients to call for vaccination appointments.
In summary, the first step is to evaluate the potential opportunity for each payers Quality Incentive Program. The second step is to develop a process to leverage the tools a pediatric practice can use to bring in patients to the practice. The last and a very important step is to have appropriate staff members consistently leverage the well visit and vaccine work list tools to call patients on this list in for an appointment and schedule these patients to be seen. Many practices have some down time in the afternoon for which the front desk team and potentially Medical assistants can make these outbound calls related to patients in need of a well visit and/or vaccination. By leveraging the pediatric practice tools in the PediatricXpress System as well as consistent management of the process can result in the practice achieving high performance of Quality Incentive programs developed by the payers.